In physio, lot’s of things we do can *seem* to work. Here are a few reasons why:

1) *Natural history*. Many of the things we see in MSK are self-limiting, they improve on their own!

2) *Regression to the mean*. Often patients will make the decision to see a physio when their complaint is at its worst. It stands to reason then, that their condition is bound to improve! Think of a flare up of back pain which almost always resolves in a few weeks.

3) *Placebo!* Not as powerful as some people claim, but it’s there!

When we perform an intervention, and things get better, it is human nature for us to think that the intervention caused the improvement. In reality, it is very hard to say this with certainty.

Another big factor is *confirmation bias*. This is another quirk of human nature that makes us see what we want to see.

Does all this mean things are hopeless? Of course not! The way I see it though, it means that determining between real and apparent effectiveness is an important skill for physios.